胸主动脉腔内修复术治疗复杂性胸主动脉夹层的临床疗效

Clinical Efficacy of Thoracic Endovascular Aortic Repair for Treating the Patients With Complicated Thoracic Aortic Dissection

目的:探讨胸主动脉腔内修复术(TEVAR)治疗复杂性胸主动脉夹层的临床疗效,报道相关临床经验。方法:回顾性分析2011-02至2015-10因复杂性胸主动脉夹层在我院接受TEVAR治疗的56例患者的病历资料,分析其手术方式的选择及原因。结果:56例复杂性胸主动脉夹层患者中21例主动脉弓解剖条件复杂,行TEVAR7例,行TEVAR、封闭左锁骨下动脉14例;主动脉夹层形态复杂16例,行TEVAR5例,行TEVAR、封闭左锁骨下动脉11例;夹层破口累及主动脉弓19例,行主动脉弓分支血管旁路术+TEVAR17例,预开窗血管支架的TEVAR 2例。所有手术均获成功,无严重并发症发生。结论:TEVAR是治疗复杂性胸主动脉夹层的一种快速、有效的手术方式,可以通过封闭左锁骨下动脉、分支血管旁路术、血管支架改良等方式扩大其应用范围。

Objective： To investigate the clinical efifcacy of thoracic endovascular aortic repair （TEVAR） for treating the patients with complicated thoracic aortic dissection and to report the relevant clinical experiences. Methods： We retrospectively analyzed the records of 56 patients with complicated thoracic aortic dissection who received the operation of TEVAR in our hospital from 2011-02 to 2015-10 in order to analyze their operation methods with reasons. Results： There were 21 patients with complex anatomic conditions for aortic arch, 7 of them received TEVAR and 14 received TEVAR with covered left subclavian artery; 16 patients with complex shape of aortic dissection, 5 of them received TEVAR and 11 received TEVAR with covered left subclavian artery; 19 patients with aortic dissection involving aortic arch, 17 of them received hybrid procedures of aortic arch branch bypass surgery ＋ TEVAR and 2 received TEVAR with fenestrated stent grafts. All operations were successful and no severe complications occurred. Conclusion： TEVAR is a fast and effective method for treating complicated thoracic aortic dissection, which may expand the application ranges as covering left subclavian artery, branch vessel bypass and modiifed stent grafting.